The recent introduction of small gauge vitrectomy instrumentation in vitreoretinal surgery provides a great opportunity for more efficient, less traumatic and safer surgery. A trocar system is used through which instruments are introduced and exchanged throughout the procedure.
Introduction and removal of the trocars require several instruments and maneuvers that are typically implemented in multiple steps. These include: (a) stabilization of the eye; (b) location of the correct trocar position in pars plana in such a way that the natural lens is not traumatized by the introduction of the trocar or instruments and in such a way as not to introduce the instruments through the retina resulting in tears that can lead to retinal detachment; (c) dragging of the conjunctiva to cause a misalignment of entry points in conjunctiva and sclera; (d) removal of the sharp blade introducing the trocar; (e) positioning of the irrigation cannula; (e) repeating the key steps above three times in the most common three port pars plana vitrectomy surgery.
Completion of these steps is crucial to the initiation of the procedure in a safe and efficient manner. Presently these are performed using multiple instruments that are repeatedly exchanged for the performance of the individual steps and for the performance of each of the three sclerotomies.